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Had Undergone TURP And Had Developed Strictures. Managing With A Intermittent Self Catheterisation. Suggest?
Question: Need some guidance on the best doctors/hospitals in India for a Urethroplasty. My father had undergone a TURP in July 2012 and had developed strictures as a result of the same. Since then he is managing with a intermittent self catheterisation with a frequency of once a week. Results of intermittent self catheterisation are not very satisfactory and hence we want to explore the option of urethroplasty
Hi,
I am not too sure of which place in India will be convenient for you logistically. I am based in Hyderabad, and can assure you that one of my mentors, Dr XXXXXXX XXXXXXX is excellent at urethroplasty. If Pune is convenient for you, you can try Dr XXXXXXX XXXXXXX He is internationally noted, and runs a centre in Pune which caters exclusively for stricture urethra. However, you also need to understand that no doctor, including Dr Sanja XXXXXXX or Dr XXXXXXX XXXXXXX will be offering a 100% guarantee that your father will not require intermittent self catheterization in future. And in fact, their opinion will be based on a recent Retrograde Urethrogram with or without a Voiding Cystourethrogram, and maybe even an endosonogram of urethra to assess chances of success post operatively.
So please do be prepared for all possibilities, including an advice to continue self catheterization, even if you visit the best!
Regards.
I am not too sure of which place in India will be convenient for you logistically. I am based in Hyderabad, and can assure you that one of my mentors, Dr XXXXXXX XXXXXXX is excellent at urethroplasty. If Pune is convenient for you, you can try Dr XXXXXXX XXXXXXX He is internationally noted, and runs a centre in Pune which caters exclusively for stricture urethra. However, you also need to understand that no doctor, including Dr Sanja XXXXXXX or Dr XXXXXXX XXXXXXX will be offering a 100% guarantee that your father will not require intermittent self catheterization in future. And in fact, their opinion will be based on a recent Retrograde Urethrogram with or without a Voiding Cystourethrogram, and maybe even an endosonogram of urethra to assess chances of success post operatively.
So please do be prepared for all possibilities, including an advice to continue self catheterization, even if you visit the best!
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. V. Sasanka,
Many thanks for your response. We live in Mumbai and Pune would be logistically convinient for us. Moreover we had heard and read about Dr. XXXXXXX Hearing his name from you as well gives us a reassurance that he is indeed a renowned expert in this field. We are currently in no hurry to get this surgery done but have started exploring this option and are gathering more information on this procedure. Also we are aware that there is no 100% surety of complete relief after this surgery.
One follow-up question which I would like to as you is as follows. While consulting one of the XXXXXXX doctors at Fortis, Mulund, Mumbai we did ask him about the option of urethroplasty. The doctor was of the view that ideally if my father can manage with a self-catheterisation he should try that first as plasty is a tedious and long drawn process. He said that first they will insert a suprapubic catheter and leave it for around two months to let the urethral passage to dry out. Post that he will do the imaging (dont know through what methods) to access the line of action for the plasty i.e. whether an anastomic would suffice or would he need grafting of sking. I have also read a lot of about plasty on the internet but have never come across this drying out method. The only longdrawn/multi-stage process I came across was jonathan's menthod, but I belive thats totally different from what he described. Could you throw some light on this matter.
Regards,
XXXXX
Many thanks for your response. We live in Mumbai and Pune would be logistically convinient for us. Moreover we had heard and read about Dr. XXXXXXX Hearing his name from you as well gives us a reassurance that he is indeed a renowned expert in this field. We are currently in no hurry to get this surgery done but have started exploring this option and are gathering more information on this procedure. Also we are aware that there is no 100% surety of complete relief after this surgery.
One follow-up question which I would like to as you is as follows. While consulting one of the XXXXXXX doctors at Fortis, Mulund, Mumbai we did ask him about the option of urethroplasty. The doctor was of the view that ideally if my father can manage with a self-catheterisation he should try that first as plasty is a tedious and long drawn process. He said that first they will insert a suprapubic catheter and leave it for around two months to let the urethral passage to dry out. Post that he will do the imaging (dont know through what methods) to access the line of action for the plasty i.e. whether an anastomic would suffice or would he need grafting of sking. I have also read a lot of about plasty on the internet but have never come across this drying out method. The only longdrawn/multi-stage process I came across was jonathan's menthod, but I belive thats totally different from what he described. Could you throw some light on this matter.
Regards,
XXXXX
Hi, Not having access to your father's urethrogram, it will be difficult for me to comment, but I imagine that the doctor felt that the disease could worsen further, and doing intermittent catheterization might be preventing us from knowing the exact extent of the disease. Hence probably the advice for SPC and delayed imaging, most likely RGU / MCUG. If there is only a short segment stricture, what we term resection of strictures segemtn and anastamosis should suffice, but I have seen many cases where the disease extent has been underestimated before the surgery and what was thought to be a simple procedure eventually needed a graft. The good news is, a graft placement is not difficult, and we do it routinely, and most patients do very well. What I would suggest is, now that I know you are in Mumbai, visit one particular good doctor, and leave it in his hands completely, and let him take the decision which he feels is in your best interests. We tend to get more confused the more we read on the net, and an insider will not have the objectivity that an outsider can bring to this kind of a clinical problem where there are no specific guidelines, and treatment would need to be tailor made for one particular set of patient and family.
Please let me know what transpires eventually.
Please let me know what transpires eventually.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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